Song J H, Lee K J, Lee S W, Kim M J
Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Inchon City, Korea.
Adv Perit Dial. 2001;17:132-7.
Laparotomic correction with or without omentectomy is occasionally required for malposition of a peritoneal dialysis (PD) catheter. We reviewed the incidence of incisional hernia following laparotomic PD catheter correction with or with omentectomy. From January 1996 to December 1998, PD catheters were implanted by non open-dissection technique using a trocar in 148 patients. Laparotomy for PD catheter malposition was required in 20 of the 148 patients. Omentectomy was performed simultaneously in 11 patients. After laparotomy, the wound was closed with interrupted or continuous layered polyglycolidelactide polymer sutures. Dialysis was resumed after the third or fourth day. Incisional hernia developed in 30% (6/20) of all patients undergoing laparotomy, but in none of the patients not undergoing laparotomy. The incidence increased when omentectomy was performed [5/11 (45.5%) vs 1/9 (11.1%)]. Multiparity, female sex, and laparotomy at a later time also predisposed to development of incisional hernia. Among the patients with incisional hernia, 2 patients showed multiple recurrences and 1 patient showed later leakage; PD catheters were lost in these patients. Another 3 patients continued continuous ambulatory peritoneal dialysis (CAPD) without a recurrence. The results suggest that incisional hernia is prevalent following laparotomic PD catheter correction, especially when omentectomy is performed simultaneously. Situations that seem to increase the risk of incisional hernia--inevitably encountered during corrective laparotomic omentectomy--are discussed. An evaluation is necessary concerning whether omentectomy acts as an independent risk factor for incisional hernia, and whether incisional hernia occurs more frequently when omentectomy is performed after a period on CAPD as compared with when it is performed at the time of PD catheter implantation. Laparotomic omentectomy should be performed as a last resort for the correction of PD catheter malposition.
对于腹膜透析（PD）导管位置异常，有时需要进行剖腹矫正术，可伴或不伴大网膜切除术。我们回顾了行剖腹PD导管矫正术伴或不伴大网膜切除术之后切口疝的发生率。1996年1月至1998年12月，148例患者采用套管针通过非开放解剖技术植入PD导管。148例患者中有20例需要行剖腹术矫正PD导管位置异常。11例患者同时进行了大网膜切除术。剖腹术后，伤口用间断或连续分层的聚乙醇酸乳酸聚合物缝线缝合。在第三天或第四天之后恢复透析。所有接受剖腹术的患者中有30%（6/20）发生了切口疝，但未接受剖腹术的患者中无一例发生。进行大网膜切除术时发生率增加[5/11（45.5%）对1/9（11.1%）]。多产、女性以及较晚进行剖腹术也易发生切口疝。在有切口疝的患者中，2例出现多次复发，1例出现后期渗漏；这些患者的PD导管丢失。另外3例患者继续进行持续性非卧床腹膜透析（CAPD）且未复发。结果表明，剖腹矫正PD导管后切口疝很常见，尤其是同时进行大网膜切除术时。讨论了在剖腹矫正性大网膜切除术中不可避免会遇到的似乎会增加切口疝风险的情况。有必要评估大网膜切除术是否是切口疝的独立危险因素，以及与在PD导管植入时进行大网膜切除术相比，在进行一段时间的CAPD后进行大网膜切除术时切口疝是否更频繁发生。剖腹大网膜切除术应作为矫正PD导管位置异常的最后手段。
